Are Flexible Dentures Covered through Medicare Advantage Plans in New York?

This is the most common question many seniors ask in regards to whether their insurance covers full or partial dentures. Most Medicare advantage plans in New York offer dental benefits with annual limits. If the dental procedure fits the dental limit for the year, Medicare Advantage Plans may cover flexible dentures.

Medicare Advantage Plans Which Offer Limited Dental:

For most cases, if the dental procedure is over the amount your Medicare Advantage Plan offers, once approved by the plan, they will only pay up to a certain limit. For instance, if your Medicare Advantage Plan offers comprehensive dental, and in their dental fee schedule, they do offer coverage options for flexible dentures up to a limit of, let’s say 1500, that means after the procedure gets approved by the plan, any amount above that you would have to pay out of pocket, and any co-pays attributed to that particular procedure.

Medicare Advantage Plans Which Offer Comprehensive Dental With No Yearly Limits:

Yes, there are Medicare Advantage Plans in New York that offer comprehensive dental coverage with no annual dollar limit. The network dentist would typically do a checkup and submit his recommendations for the dental work to your Medicare Advantage Plan for approval. In regards to flexible dentures, if this procedure is in the dental fee schedule, and it get’s approved by the plan, no matter what the cost is for the Flexible Dentures, your responsibility will by the co-pays assigned to that particular procedure, which is typically 0 or low copay for top and bottom, or separately for top, and separately for bottom.

If you don’t know if your plan has comprehensive dental coverage, you may do the following:

• Check with your Medicare Health Advisor
• Request the summary of benefits from your Medicare Advantage plan and look for the dental section
• Request the Evidence of coverage, which is a summary of your benefits, but in much greater detail
• Ask your plan to send your dental provider the Fee Schedule for dental. Some dentists are unaware that certain Medicare Advantage Plans do cover Flexible Dentures. They usually fall under the “Maxillary Partial Dentures – Flexible” or “Mandibular Partial Denture – Flexible Base”

Why Flexible Dentures?

Flexible dentures are a clear soft base that allows your natural gums to show through; compared to regular dentures, clips, attachments, and adhesives are not needed because these dentures cling to the gums. Flexible dentures are comfortable than regular dentures, put less strain on your mouth,  endure less pain especially with chewing food or speaking.

Important questions to ask your Medicare Health Advisor or Medicare Advantage Plan:

• Do I have comprehensive and preventative dental coverage?
• Does the dental coverage have yearly limits?
• What are the co-pays associated with different dental procedures?
• If I don’t have dental coverage, can I add a rider to the insurance to get dental coverage and how much will the monthly premium be? Would this dental coverage have limits, and would it be comprehensive or preventative, or both?
• Which dental providers accept my Medicare Advantage Plan and can I attend a hospital to conduct the procedure?

For More Information or Advise:

Contact us if you have any questions or need additional information to find out which Medicare Advantage Plans offer dental benefits suited to your needs – Click Here